I have doubts that insulin resistance is a metabolic state that can be totally reversed. I only believe in remission.
Insulin resistance is a time dependent condition. The longer the person has had it, the more difficult it is to reverse. This is why someone who has been obese, for most of their life, has a much harder time keeping weight off than the person who was only recently overweight. The metabolism of the person that has had a chronic obesogenic hormonal profile, will always struggle, even in the best of circumstances.
Though this metabolic pathology has the hallmark of insulin resistance, insulin is not the be all/end all of the condition. The entire neuroendocrine system has been affected and there are now multiple compromised feedback loops that aren't resolved by simply normalizing insulin function. This is why the insulin hypothesis (IH) is incomplete. It does not explain obesity in its entirety, only partially. It is a large, necessary piece of the puzzle, but not the entire puzzle.
For this reason, continuing a fasting and dietary regimen, for life, is crucial. That is why sustainability is paramount. The person has to view these interventions as lifelong approaches, not temporary fixes.
2. Is high intensity exercise the most effective?
No.
Humans, "in the wild", do not do high intensity anything. Unless the human is running from a predator, he pretty much does nothing, but frequent, low intensity movement. Even without a spear or gun, humans just injure large animals and track them, until they drop on their own. No intensity required. It's in our nature to conserve as much energy as possible. No wonder there are so many people who just don't like exercise, unless they are interested in athletics. It seems like we never evolved to do anything chronically of high intensity, especially without purpose.
You can also view the lives of athletes, as an example. The more intense the exercise, the worse these people's health is later in life. You would think, that all of this exercise would make athletes visions of health, in their later years, but if they even get there, the benefits are minuscule. They are all plagued with injuries, surgeries and chronic pain, which require lifelong medications that eventually affects their metabolism. They do not seem to have an advantage over heart disease, cancer, neurodegeneration, aging and all the other maladies that everyone else suffers from either. It's as if they reach a peak and then have to continue the high intensity regimen to continue seeing benefits, but as we get older it becomes harder and harder to do that and the exercise did not save them from this reality.
There certainly is a sweet spot for just the right amount of exercise at the right dose. There is something very natural about long walks, that raise your heart rate and keep you moving and burning fat for a long time, without the need for intensity. Long walks is how we were made to move and that's why you see maximum benefits from it. Not to mention the benefits in range of motion exercises like Yoga, climbing and dancing. You want to build a large muscle mass, not necessarily larger muscles. Hunter gatherers are ripped, without looking like bodybuilders. They also maintain that muscle mass, through completely natural movement, while body builders have to persistently do abnormal movements to maintain theirs.
3. Should you never burn glucose for fuel?
It's not that you should never burn it, it's that you simply don't.
Glucose is a fuel that is used for sporadic, short term, high intensity requirements, like running from a predator or fleeing for your life after a volcano blows. Unless you are a competitive athlete, it is unlikely you will ever require to burn glucose in any significant way. Glucose is required for the function of certain cells in the body, but that cannot be considered "burning glucose for fuel" in any meaningful way. Other than that, the body runs on fat.
4. Obesity cannot be a hormonal disease, because doctors never mention hormones to describe it.
This is because it is not necessarily a "hormonal disease".
It's a metabolic state that can cause pathology over time, but its not a true "disease". The metabolism of the obese is not doing anything wrong. It's doing exactly what it's suppose to because of the state it was put in. Disruptions in blood glucose homeostasis cause a starvation adaptation that increases blood glucose, insulin and body fat weight set points.
5. When you get fat, you get fat equally.
Cells actually compete for calories, so you do not ever get fat equally. Energy is always partitioned by the body. In other words, it decides where the energy goes, not you. If you could decide where the energy went, then you could basically live forever and prevent all kinds of systems, in your body, from failing.
Instead, adipocytes (fat cells), myocytes (muscle cells), etc. all compete differently for fuel and this competition is driven by your hormonal state, which determines your body composition. Hormones are what tell the body what to do with its calories. They are the true regulators of energy balance. You certainly don't want your fat cells taking up all your calories, at the expense of other cells, that need fuel to burn.
Having all your calories go into your fat cells, means they will end up in storage and will soon exceed fat cell capacity, while the rest of you continues demanding more fuel. This is one of the pathological states of insulin resistance.
6. Is insulin the only hormone that can make you fat?
Insulin is always implicated in becoming fat. It is the body's main anabolic hormone and easily manipulated with diet. This is why it's usually the one that is focused on. But, the myopic view that insulin is the sole hormone to blame, for metabolic dysregulation, is not the correct approach.
Metabolic disease is not as simple as cherry picking out one hormone and blaming it for everything from high blood glucose to climate change. There are actually 12 metabolic hormones and they work together to keep metabolism in homeostasis through a series of complicated feedback loops. If one of them is off, it affects all the others, in a cascade. Aside from those, there are multiple other systems in the body that regulate weight, including the hypothalamus in the brain, which these hormones communicate with. This is why obesity is very complicated.
The only thing you need to know is that proper blood glucose regulation keeps these hormones working correctly.
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